Would you treat a patient with Radium 223 for prostate cancer with mainly bone metastasis if he has a history of osteonecrosis of the jaw bone from bisphosphonate/Denosumab?

This is a good question, and one that has very little evidence to answer. Certainly there is some risk of ONJ due to radium 223 from case reports in the literature. There have also been successful palliative treatments with radium in men with bone mCRPC, despite ongoing ONJ due to bisphosphonates:

Us...